Waste

In the lean philosophy, any work that doesn’t add value is waste. Waste should be eliminated. That’s not a value judgment on the people doing the work. People shouldn’t have to endure wastes like awkward movements of bending and twisting, looking for supplies or information, clicking too many times when using software, or rushing to prepare a report with bad information that will have to be reworked later. People feel these wastes, and they are ready for better. In my opinion, waste contributes to burnout. People don’t mind working, but it bothers them when their effort is wasted.

Value is determined from the customer’s perspective, waste from the worker’s perspective. Understanding what category of waste an activity falls into can set us on the path to eliminating the waste. The mnemonic to remember the seven wastes is TIMWOOD.

Transportation: Moving patients, materials, and information (including electronic transport of information). Examples: a patient being wheeled down the hall; a phlebotomist running to the lab with a blood sample; vials of reagents moving along a conveyor belt to be filled, sealed, and labeled.

Inventory: Materials, information, products, and people waiting to go through the process. Examples: insurance claims waiting to be approved; people waiting in a hair salon because the hairdresser is running late; e-mails waiting to be read. Note: Even though excess inventory appears to “wait,” it’s an inventory waste. Running out of inventory is a defect that leads to an operator or machine having to wait.

Motion: Unnecessary movement of an operator when not transporting something, including excessive and awkward movement. Examples: excessive clicking to navigate through software; looking in three supply areas for the paper towels; reaching overhead to get medication off a top shelf.

Waiting: Operators waiting to perform their contribution to the process. Examples: a tech waiting for the patient to arrive; a financial analyst waiting for data; a nurse waiting to receive an antibiotics order for a patient.

Overproduction: Making more than is ordered or sooner than needed – the worst waste, according to Mr. Ohno. Remember those pictures of parking lots full of new cars waiting to be sold? That’s overproduction. Examples: making too many copies of a report or making it sooner than needed, so that when a defect is found, the copies have to be scrapped; a second MRI on a patient arriving in the ER, because the report from the first scan isn’t available yet.

Overprocessing: Unnecessary work or effort. Examples: the copy-and-paste of documentation between different software systems; reading through redundant information in a patient’s chart; the multiple times a financial report is re-worked.

Defects: A non-conformance or departure from expected service or product quality, including information as well as decisions and actions. Examples: the wrong birthdate in a patient’s chart; an order for 12 packages of adhesive bandages that results in 12 cases being delivered; a patient getting the wrong medication. When looking at defects, we also want to investigate errors or mistakes that could result in a defect, for example, a “near miss” with a wrong medication – staff should not be asked to endure the stress of almost causing harm. Errors are wasteful too, and we need to surface these and prevent them from occurring, so that we can respect people and work toward zero defects.

Some organizations break out an eighth waste that speaks to lack of respect for people and often has to do with mismatch of skills to the work and inadequate training. Examples: a physician doing clerical data entry; a nurse practitioner being asked to operate above her licensure; a research scientist packaging an HIV test kit.

All jobs in all industries can benefit from the removal of waste. The ultimate respect for people is to have their work, their thinking, their effort count—to support people in making a difference. This means eliminating waste in processes. Are we showing respect for consumers and staff when we have wasteful processes?

Speaking about healthcare, Warren Buffet said, “… take the cost out of the system.” That’s equivalent to removing waste. Eliminating waste improves quality, reduces cost, and improves customer and staff satisfaction. Now is the time to work on eliminating waste in all aspects of healthcare: direct care, insurance, pharmaceuticals, medical device manufacturing, and research.